South Africa: Women, AIDS, and Violence, 2

Editor's Note

"In the Southern African region the results of a large scale
household survey conducted in eight countries showed that nearly
a fifth of the women interviewed reported being a victim of
partner physical violence in the preceding year. ... South African
based-studies have found that women who experience intimate
partner violence are at long-term increased risk of HIV infection,
particularly where their partners were involved in multiple
concurrent, unprotected sexual relationships." - Amnesty
International

In a report released in March, based on interviews in two South
African provinces and extensive consultation with South African
agencies involved with the issue, Amnesty International provides a
detailed portrait of the situation of rural women, and the
interaction among violence, poverty, and the risk of HIV/AIDS. The
report's title, quoting one of the women interviewed, is "I am at
the lowest end of all."

The full 124-page report is available athttp://www.amnesty.org/en/library/info/AFR53/001/2008/en
In this and another issue sent out today, AfricaFocus Bulletin
provides brief excerpts from the report's overview and the section
on violence against women. The overview also provides a useful
concise survey of the development of the AIDS epidemic in South
Africa, including the debates about government policy and the
active role of civil society.

"He threatened to kill me and burn down the house if I did not take
him back ... So I returned back to stay with him." [Testimony of
SS who had been raped and repeatedly beaten by her husband and was
fearing receiving the results of her HIV test.]50

"In spite of ample empirical evidence to this effect, states have
yet to fully acknowledge and act upon the interconnection between
the mutually reinforcing pandemics of VAW and HIV-AIDS". (UN
Special Rapporteur on Violence against Women, July 2007)51

South Africa is continuing to experience a major HIV epidemic
within a context of persistent and high levels of violence against
women (VAW). As noted in the UN Secretary-General"s Study in 2006
on patterns and consequences of VAW, this is a global phenomenon
which is both a violation of women"s human rights and prevents
women from enjoying other human rights and fundamental freedoms.
...

The South African Constitution of 1996 guarantees that everyone has
the right to freedom and security of the person, which includes
"the right ... to be free from all forms of violence from either
public or private sources".54 Despite this constitutional guarantee
thousands of women and girls experience sexual and other forms of
violence every year in South Africa. In July 2007 the national
Minister of Safety and Security, Mr Charles Nqakula, observed from
analysis of the past six years of crime statistics that "the fact
that instances of serious and violent crime are very high is
disconcerting and unacceptable." They included rape, "indecent
assault"55 and attempts to commit these crimes. The Minister also
observed that "poorer communities" were experiencing "more violent
crime than wealthier ones," and "at least two thirds of all
serious and violent crimes happen between people who know one
another and who will be found mostly within the confines of the
same social environment.56

As is evident from the Minister"s comments, violence or the threat
of violence is a pervasive problem for many people in South
Africa. Women and girls can experience gender-based violence or
witness it from a very early age. Indicative of the scale of the
problem were the results of a national survey conducted in the
early 2000s, in which a third of the 1,000 women interviewed had
experienced physical, sexual, emotional and economic abuse, most
typically in their home environment, and two-thirds had experienced
at least one form of abuse. The South African Human Rights
Commission (SAHRC) concluded after hearings on school-based
violence in 2006 that schools were the "most likely place where
children would become victims of crime including crimes of sexual
violence". A national cross-sectional study of nearly 270,000 high
school students in 2002 identified an "expectation of sexual
coercion among the youth".57 A majority of the women whom AI
interviewed in May 2007 had experienced, witnessed or were aware
of incidents of violence in the home or rapes occurring in the
wider community, including in schools or while en route to school,
or on farms where some of the women had worked as seasonal
contract workers.

The consequences for the health and psychological well-being of the
women and girls subjected to these forms of violence can be
devastating. At the same time violence against women and girls can
have damaging psychological effects on boys who witness their
mothers being beaten or their sisters" abuse at the hands of
fathers and partners. Research evidence indicates that men who had
witnessed domestic violence during their childhood were
responsible for significantly higher levels of abuse against women
in their adult lives, as opposed to men who had not witnessed
violence against women in their childhood.58 For women and girls
experiencing violence and abuse, the consequences are immediate,
but can also be longer-term, including through provoking a change
of behaviour in the victim. ...

Sexual violence and its consequences

"We live in fear. There is nothing we can do to protect ourselves."
(Testimony of LE, a rape survivor living with HIV in rural KwaZulu
Natal)61

...

The World Health Organization has commented on the "profound
impact" of sexual violence on the physical and mental health of
survivors. Its impact can include physical injury and is
associated with "an increased risk of a range of sexual and
reproductive health problems, with both immediate and long-term
consequences." There is also a serious and possibly long-term
impact on the victim"s mental health.63 The link between
gender-based violence and HIV is most apparent in respect to the
crime of rape, which can lead to direct HIV transmission. Due to
the high HIV prevalence and high levels of sexual violence in South
Africa, women are at risk of contracting HIV as a consequence of
rape.64 ...

Reported cases of rape amounted nationally to 117 per 100,000 of
the population in the financial year April 2006 to March 2007,
with a range from 80.6 (Limpopo) to 142.8 (Northern Cape) in the
nine provinces.69 Research and support organizations believe,
however, that the actual figures annually are much higher than
those cases reported to the police, because of the social and
economic pressures which discourage women from reporting rape.70
...

Police analysis in 2007 of reported cases indicated that "76 per
cent of rapes covered by the sample studied involved people known
to one another." In just under a fifth of the total cases the
perpetrators were relatives.72 Women in certain areas also seem to
be at greater risk of violence. From an analysis of crime patterns
at the police station area-level, it appears that 40 per cent of
the cases of rape and other "socially motivated contact crimes"
such as murder and assault with intent to cause grievous bodily
harm (assault GBH), which were reported in 2006/2007, had occurred
in only ten per cent of the 1,105 police station jurisdictions.73
Of the areas where AI conducted its interviews in May 2007, all
but one fell within the areas of the police stations with the
highest reporting rates.

These official statistics and accompanying analysis indicate that
many South African women live in a general environment of high
levels of violent crime, including rape, which affects their lives
at home, in the community and wider society, placing them at risk
of HIV infection in an accompanying context of high HIV prevalence
levels.

Among the women whom AI interviewed, a number of them reported
being raped and living in a generally threatening environment.

...
The sense of vulnerability experienced by women living in unsafe,
poorly policed areas is also evident in the comments of
39-year-old EZ, who was living with her three children and two
grandchildren in Mpumalanga. She told AI that she was worried about
the safety of her girls and tried to prevent them from taking
risks, such as going out at night or going to shebeens.76 In
addition she worried about their vulnerability as a female-only
household."I am trying to keep it quiet that I am staying alone
without a man in the home," she told AI.77
...
Some initiatives have been taken by the state to improve the
criminal justice response to crimes of rape and to a lesser extent
to address the lack of safety in local communities. The former
initiatives include:

ò strengthening the coordination of the work of police
investigating officers and medical practitioners involved in
examining rape survivors and gathering forensic evidence and, in
some cases, the development of "one-stop" centres for the provision
of medical, investigative, prosecutorial and psychological services
for rape survivors;

the development of national policy guidelines for the handling
of victims of sexual offences and national management guidelines
for care of victims of sexual assault;

the development of specialised sexual offences courts which have
achieved a higher conviction rate in the prosecution of rape and
other sexual offences;

the training of criminal justice personnel including police in
the principles of "victim empowerment" and the establishment in
some police stations of "victim friendly" facilities, often in
collaboration with NGO support organizations;

the reform of the legal framework for prosecuting sexual
offences, in particular by widening the definition of what
constitutes rape to include oral and anal, as well as vaginal,
penetration by a body part or object without the consent of the
victim, which may be confirmed by the presence of "coercive
circumstances"; and, more controversially,

minimum sentencing legislation in cases of rape.81

However a number of concerns remain. The Department of Justice and
Constitutional Development appears to have decided not to expand
the development of the specialised sexual offences courts. Rape
remains a difficult crime to prosecute and requires a high level
of training for prosecutors and presiding officers. In the
ordinary courts the conviction rates are low. In a recent study of
the outcomes of over 2,000 police investigation cases in Gauteng
province, 359 of the cases went to trial resulting in convictions
for rape in about 87 cases, equivalent to less than five per cent
of the original group.82 Advocacy organizations who were involved
in the decade-long process of reforming the sexual offences
legislation have expressed concern that the final version of the
reformed law has eroded the protections afforded to rape
complainants and other vulnerable witnesses contained in the
initial draft law.83

...

Finally, in regard to prevention, much more needs to be done by
municipal authorities in cooperation with the police, businesses
and local rural communities to improve women"s physical security
by identifying and addressing threats to their safety in the
physical environment. AI visited a number of areas where poor or
no lighting, high bushes along pathways and inadequate transport
links increased the risks of violence for women and girls on a
daily basis. Police management could also give greater priority to
increasing the level of personnel, vehicles and equipment for
rural-based police stations.86

Domestic Violence as a long-term threat to women"s health

"To the extent that [domestic violence] is systemic, pervasive and
overwhelmingly gender- specific, domestic violence both reflects
and reinforces patriarchal domination and does so in a
particularly brutal formà.The non-sexist society promised in the
foundational clause of the Constitution [section 1], and the right
to equality and non-discrimination guaranteed by section 9, are
undermined when spouse-batterers enjoy impunity."87 (South African
Constitutional Court in S v Baloyi)

Domestic violence, particularly intimate partner violence, may
involve physical and sexual violence, as well as threats of
violence and psychological and emotional abuse, and has been
identified by the WHO as a serious health problem internationally
affecting up to 60 per cent of women across different countries.
88 The phenomenon is defined by unequal gender relations and has
an impact on women"s ability to protect themselves from HIV
infection. The UN Committee on the Elimination of Discrimination
against Women (CEDAW), in General Recommendation 19,89 described
"family violence as one of the most insidious forms of violence
against women" which is evident in "violence of all kinds" and
underpinned by "traditional attitudes" and a lack of economic
independence which forces many women to stay in violent
relationships. CEDAW concluded that "[t]hese forms of violence put
women"s health at risk and impair their ability to participate in
family life and public life on a basis of equality."

In the Southern African region the results of a large scale
household survey conducted in eight countries showed that nearly
a fifth of the women interviewed reported being a victim of
partner physical violence in the preceding year. The study found
that men having multiple concurrent partners was significantly
associated with the occurrence of partner physical violence.
Another significant factor associated with violence was the holding
by men of certain attitudes about sexuality and sexual violence.
These beliefs included that women do not have the right to refuse
sex to husbands and boyfriends; that forcing one"s partner to have
sex is not rape; and women sometimes deserve to be beaten. The
women who reported experiencing partner physical violence were
significantly more likely to believe that they were at risk of
getting HIV.90 South African based-studies have found that women
who experience intimate partner violence are at long-term
increased risk of HIV infection, particularly where their partners
were involved in multiple concurrent, unprotected sexual
relationships.91

The scale of the problem in South Africa has been difficult to
assess accurately as the police do not appear to keep separate
figures for "domestic violence" or at least include them in their
public crime statistics. However, in late 2007 the SAPS submitted
reports to the Parliamentary Portfolio Committee on Safety and
Security in which they noted a total of 88,784 "domestic violence
incidents" had been recorded between 1 July 2006 and June 2007.92
These cases would have included a range of forms of abuse as, under
the 1998 DVA, "domestic violence" is defined to include physical,
sexual, emotional, verbal, psychological and economic abuse;
intimidation, harassment, stalking, damage to property; entry into
complainant"s residence without consent where the parties do not
share the same residence; or any other controlling or abusive
behaviour towards a complainant, where such conduct harms, or may
cause imminent harm to the safety, health or well-being of the
complainant.93 Between April 2006 and March 2007, 63,000
applications for protection orders, under the terms of the DVA,
were confirmed by the courts.94

Further insight into the levels of violence which may be affecting
women in their homes can be gleaned from the SAPS crime statistics
for incidents of assault GBH. The SAPS noted that a quarter of the
perpetrators were relatives and in nearly 90 per cent of the cases
the victim knew the perpetrator.95 The actual number of reported
incidents of assault GBH for the year 2006/2007 û 218,030 û is
indicative of serious levels of interpersonal violence, with one
quarter or some 55,000 incidents involving family members.96 To
these figures could also be added the number of cases of murder or
attempted murder, both of which could be relevant for an analysis
of domestic violence trends. South African legal researchers
reviewing the results of community-based, local and regional
studies noted that the estimates range from one in two to one in
six women experiencing domestic violence.97 A hospital-based survey
reported that more than one third of women from a low-income
community had experienced domestic violence at some stage.98 Half
of all South African women killed in 1999 were "killed by their
intimate partners, with violence a factor in many of these
relationships."99

...

Nearly ten years after the DVA came into force and after the
provision of training on their obligations by official and civil
society organizations, there is still evidence that some members
of the SAPS do not understand their legal responsibilities or do
not feel under sufficient pressure to fulfil them. A view that
these are "family matters" still persists among some police
officers, an attitude which may be reinforced by policing
priorities which emphasise combating crimes which have an impact
on the economy and more influential sectors of society. The
professionalism of the police response to reports of domestic
violence may also have been weakened by the decision taken in 2006
by police management to decentralise specialist police units,
including the FCS. Members of the Unit have been redistributed to
local police stations, but in a manner which appears to have left
them without adequate support and at risk of being deskilled.109

...

Finally, urgent attention is needed to increase information about
and the availability of places of safety. All of the women
interviewed by AI, when asked if there were shelters for women
experiencing violence in their homes, replied that they were not
aware of any. Their only resort was to go back to their parents or
other relatives" homes, but with the risk of being found. A
support organization in Mpumalanga informed AI that they were aware
of one shelter which allowed a woman to stay for three months,
including with her children, but transport was difficult to
arrange. According to the national Department of Social
Development, which is responsible for approving provincial plans
within agreed national policy guidelines, in addition to the
Louieville Women"s Support Centre in Mpumalanga which was opened
in 2002, a further shelter was opened in 2006, in Badplaas, and
planning for a third one was underway.110

...

Conclusion

The period of democracy in South Africa since 1994 has coincided
with the most intense increase in the prevalence of HIV and the
feminisation of the epidemic. The legacies of the apartheid period
- the deliberate underdevelopment of black residential communities
and rural "homeland" areas, the lack of effective policing apart
from reasons of political repression, and the racially skewed
delivery of health and other social services and access to
education - still pose major challenges to a government under
pressure to respond more immediately, effectively and
compassionately to the problems of persistent poverty, high
unemployment, preventable diseases and the consequences of violent
crime. Although the formal, legal status of women and the level of
their participation in political life have improved enormously
since 1994, women, particularly rural women living with HIV who are
the focus of this report, are disproportionately affected by
poverty and unemployment. They continue to experience
discriminatory attitudes and practices, particularly from male
partners, and to live in a general environment of high levels of
sexual and other forms of gender-based violence.

AI concluded from the research conducted for this report that there
is evidence indicating that the realization of the women"s right
to the highest attainable standard of health is impeded by:

the lack of secure income which affected their ability to access
health services and adequate food, although the state provision of
various kinds of social grants mitigated the worst effects for
some women;

the lack of affordable and reliable transport enabling them to
reach HIV-related health services urgently or for necessary
monitoring, treatment and care;

the still limited availability of comprehensive HIV services
including ART in rural areas due to severe staff shortages, some
which appeared to be caused by the lack of due diligence on the
part of department of health officials responsible for recruitments
and planning, particularly in Mpumalanga province, but also by the
competitive pressures from the private sector and foreign
governments;

the still limited accessibility and availability of
comprehensive HIV services including ART in rural areas due to
blockages in the accreditation process, particularly in Mpumalanga
province, for certifying sufficient, decentralised facilities to
offer these services, although positive trends are emerging in some
provinces in this regard;

the impact of sexual and other forms of gender-based violence on
the women, who had been exposed to the risk of HIV infection
through coercive unprotected sex and/or from the longer-term
consequences of living in abusive relationships;

the impact of other forms of discrimination against women and
social stigma attached to HIV and AIDS which impeded their ability
to make the best decisions for their health, including being able
to refuse unprotected sex and undergo HIV testing without risks of
verbal abuse, violence or threats of violence and abandonment;

the impact of the obstacles to their access to legal remedies
due to still inconsistent practices, poor training and
under-resourcing in the police response to crimes of violence
against women in rural areas; and

the impact of the lack of information on or actual shortages of
shelters for women experiencing domestic violence.

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